Business as usual

So with bruising settling and stitches out but scabs difficult to resist it is back to business as usual or at least sort of, naturally of course the local tittle tattle and politics continue unabated.  The ward remains quite quiet as the only way you can get through the door now is if you have money or you can get a voucher.  Money means middle class and they arrive with gold and their own sheets, so not difficult to spot.  Voucher means one of 4 local kebelles, mostly in relatively rich coffee growing areas but high on the hills (thus transport difficult) there are still problems and mostly the problems we see were (currently no car) scooped up by Karen on her travels, I think they look out for her now, and then brought in for derision and neglect at the hands of our caring midwives.  They are of course currently a little pissed off as the withdrawal of birth funding has been withdrawal of their extra pay, and with that of course good will.  But then of course it is a damn sight safer than being at home.  Recent e mail correspondence suggests that a similar scenario may soon be being acted out in the U.K. as pension raids are taking place.  One of the bores of all this patient transport stuff apart from the odour of unwashed body (not their fault, no water) is that lack of access to wheels means that they are very prone to motion sickness.  Partially digested injera, when projectile, which sadly it usually is, has a smell all of its own which engenders greater nausea, so the results are not pretty and the carpets only partially protected.  The water tank at the back has proved particularly useful on occasion.  My idea of producing sick bags purloined from our recent travels has worked reasonably well but they are clearly useful to those who have little so if not used for the designed purpose they are nicked and used for carrying chat or whatever.  However all this is in the distant past as currently the wheels are in Addis being panel beaten (we hope) or just open to the elements and partially repaired then abandoned in the wet season.  As we are not there and the stories of progress, or more likely lack of it, are increasingly vague who knows.  What we do know though is that glass is very expensive and there is none of this insurance stuff.  This has driven Karen to hire of crappy taxi (unreliable and picking up fares at her expense when not broken down on the road) or use of hospital car.  Remarkably helpful and allowed to drive it on her own until urgent calls for its return as urgent letter needed delivery.  Sounded suspiciously like administrative cock up to me, but these are an everyday occurrence here.  Forward planning is not well developed in these parts, which is another parallel with the NHS at home I suspect.  Although ante natal care is at best scanty some messages are getting through as a 4 foot nothing lady with a previous scar and dead baby turned up at term and surprisingly not in labour at the clinic in time for her this time successful elective section as did another, so 4 lives saved which is I suppose a result.  The lass with severe pre eclampsia and an equally severely growth retarded baby is doing ok despite continuing to pour all the third spaced fluid through her wound but the supply of NAN (baby milk) is running low and her supply of breast milk is equally thin, so the situation is a little bleak.  Not as bleak though as for the wretched child next door, who was like the majority of babies here was plucked out of the womb with fetal distress and thick meconium but unfortunately decided to breath some of it in with predictable results.   So antibiotics, fluids and oxygen, though concentrators so not much of that but still in with a chance.

Meanwhile our sponsors are busying themselves with drug supplies for the supported clinics, as the available drugs (largely unnecessary methyl dopa as not much chronic hypertension rather than useful magnesium sulphate and no even more useful misoprostol as bleeding kills) and sadly limited supplies of iron.  They actually have quite a lot as they sit there out of date.  I wondered why and the answer is that they are locked away and those doing the clinic cannot be bothered to get them.  That possibly explains why I recently saw someone quite anaemic being sent away with 4 folate tablets.  The government however is now apparently giving away iron (high time too) but predominantly to ante natal women though if they were sensible they  would horde them for their post natal use as it is when they have bled and they are trying to breast feed is when they will find them most useful.

Why though you may wonder is all this ‘obstetric ordinance’ being bought.  The answer, like to most things here is of course political.  The charity in order to survive has to show that only 30% of the cost is administration, though in fact most of its costs are salaries or expensive car journeys.  What better way to offset this than give away a few tablets, drip sets etc., then these can be locked away until they go out of date.  Locked away unless they get stolen, by of course the person with the keys……..When you do get to them they are so mean that they would worry a homeopathist.

One of the things that seems to mark the Ethiopian situation is the inability to get it together either chronically or acutely. I was persuaded to an Adventist peripheral clinic last week and saw 21 people the majority of whom had come on the off chance that they could get a free prolapse operation, which is a pity as the ‘prolapse tourists’ had left some weeks before and had had nothing to do for the last two days, let’s hope that if and when they return in November that these poor people will return as advised and some one will know that there is a team approaching.  Acutely it is sadly business as usual too with acute fetal distress at full dilatation.